Healthcare Provider Details

I. General information

NPI: 1932286267
Provider Name (Legal Business Name): PATRICIA OLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W 1ST AVE
TOPPENISH WA
98948-1564
US

IV. Provider business mailing address

PO BOX 190
TOPPENISH WA
98948-0190
US

V. Phone/Fax

Practice location:
  • Phone: 509-865-5600
  • Fax: 509-865-5783
Mailing address:
  • Phone: 509-865-5600
  • Fax: 509-865-5783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD61581682
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL6552
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: